Regardless of which medical school they attended or which specialty they were trained in during residency, physicians rarely get much education on the topic of health care policy or politics. Yet every day, decisions in boardrooms, courtrooms and legislative back rooms have the bottom-line effect of interfering with what matters to doctors most: patient care.
That is where the AMA comes in. In a recent episode of “AMA Update,” two otolaryngologists and AMA leaders—President-elect Bruce Scott, MD, and Board of Trustees member Bobby Mukkamala, MD—discussed physicians’ need for broad policy support and how, through its Recovery Plan for America’s Physicians, the AMA fights for physicians on critical issues so they can stay focused on their patients.
Organized medicine groups such as the AMA have the power to compel political change that benefits patients and doctors, the two elected leaders noted.
These priority issues include:
- Fixing prior authorization.
- Reforming Medicare payment.
- Fighting scope creep.
- Supporting telehealth.
- Reducing physician burnout.
Fighting—and winning—on prior auth
“Prior authorization is one of the greatest administrative burdens that takes physicians away from providing care to our patients,” said Dr. Scott, who practices in Louisville, Kentucky. “And it harms patients as well.”
AMA research has shown that on a national level, large percentages of physicians report that prior authorization results in delayed and denied care and ultimately harms patients. Dr. Scott said the payer cost-control practice is particularly bad for otolaryngologists because, as specialists, they do complex procedures and order advanced imaging that are often subject to prior auth.
“In my own practice I deal with the burden of prior authorization every day. Part of my frustration is that the person on the other end of the phone has never had an opportunity to get a history from the patient, examine the patient—and what's even worse—a lot of times they haven't even been to medical school,” Dr. Scott said. “Rarely, in my experience, are they otolaryngologists. Heck, most of the time they can't even pronounce otolaryngology.”
As a result, Dr. Scott often finds himself talking to someone who's making the decision about patient care who simply does not have the knowledge to do so. But recently, the AMA has stepped in and has been successful in influencing change, he said.
“We were able to convince the Center for Medicare & Medicaid Services [CMS] to pull back on prior authorization for Medicare Advantage plans, for Medicare, for Medicaid and the other federal funded plans. These differences will be implemented [and] will make prior authorization less of a burden. Now what we need to do is extend that to the private health plans as well,” he said.
Medicare pay, scope creep
Pay cuts are another major challenge, Dr. Scott noted.
“Physicians face this annual cycle, like we did again this year, where we're facing a payment cut. It's simply not sustainable. And the problem is that patients' access will suffer. Physicians that I know—including otolaryngologists—are already limiting the number of Medicare patients that they can see. Others have stopped accepting new Medicare patients, and some are considering dropping out of Medicare completely.”
Learn more with Dr. Scott about what doctors wish patients knew about Medicare physician payment.
Challenges also exist at the state level, where state medical societies take on regulatory issues—with help from grants through the AMA Scope of Practice Partnership, noted Dr. Mukkamala. In Michigan, where he practices, nonphysicians are aggressively seeking to expand their scope of practice so they can treat patients without physician supervision. For example, audiologists want the ability to take care of Medicare patients without the involvement of otolaryngologists.
“We call that out as inappropriate,” Dr. Mukkamala said of the AMA. “And these are the battles that come back year after year after year in all 50 states. The knowledge of what worked to defeat it in one state is critical when that battle comes to our state, and that knowledge is what the AMA brings.”
State medical and national specialty associations are important allies in physician advocacy, but Dr. Mukkamala went on to say, “they alone cannot handle all of this. We need to group together as physicians united on those issues that affect all of us—and particularly, those issues that affect us as otolaryngologists.”
“The pharmaceutical companies are not going to watch out for us,” Dr. Scott added. “The insurance companies are not going to watch out for us. The AMA is the organization that cares about our whole profession and our patients.”
“AMA Update” is your source for physician-focused news. Hear from physicians and other experts on trending public health concerns, practice issues and more—because who’s doing the talking matters. Catch every episode by subscribing to the AMA’s YouTube channel or listen to all AMA podcasts at ama-assn.org/podcasts
